@extends('layout/wap2')
@section('headcss')
@stop
@section('content')
    <div class="board-form">
        <form action="/dofbxr" method="post" enctype="multipart/form-data" id="fbxr">
        <div class="container">
                <?php echo method_field('POST'); ?>
                <?php echo csrf_field(); ?>
            <h1 class="title"> 失踪人基础信息</h1>
            <ul>
                <li>
                    <div class="label">编号</div>
                    <input type="file" name="code" value="{{$code_nums}}" disabled="disabled"/>
                </li>
                <li>
                    <div class="label">相片</div>
                    <input type="file" name="miss_pic"/>
                </li>
                <li>
                    <div class="label">姓名</div>
                    <input type="text"  id="miss_name" name="miss_name" placeholder="必填，失踪人姓名"/>
                </li>
                <li>
                    <div class="label">性别</div>
                    <input type="text" id="miss_sex" name="miss_sex" placeholder="必填，失踪人性别"/>
                </li>
                <li>
                    <div class="label">出生日期</div>
                    <input type="text" id="miss_brath" name="miss_barth" placeholder="请选择失踪人出生日期"/><span class="bx"></span>
                </li>
                <li>
                    <div class="label">籍贯</div>
                    <input type="text" id="miss_home" name="miss_home" placeholder="请选择失踪人籍贯"/><span class="bx"></span>
                </li>
            </ul>
            <h1 class="title"> 失踪信息</h1>
            <ul>
                <li>
                    <div class="label">失踪日期</div>
                    <input type="text"  id="miss_date" name="miss_date" placeholder="请填写失踪日期"/><span class="bx"></span>
                </li>
                <li>
                    <div class="label">失踪时身高</div>
                    <input type="text" id="miss_high" name="miss_high" placeholder="请填写失踪时身高"/><span class="bx"></span>
                </li>
                <li>
                    <div class="label">失踪地点</div>
                    <input type="text" id="miss_access" name="miss_access" placeholder="请填写失踪地点"/><span class="bx"></span>
                </li>
            </ul>
            <h1 class="title"> 其他信息</h1>
            <ul>
                <li>
                    <div class="label">特征描述</div>
                    <input type="text"  id="miss_face" name="miss_face" placeholder="请填写失踪人体貌特征，对找人更有利"/><span class="bx"></span>
                </li>
                <li>
                    <div class="label">失散经过</div>
                    <input type="text" id="miss_experience" name="miss_experience" placeholder="请填写失散经过"/><span class="bx"></span>
                </li>
                <li>
                    <div class="label">酬金数额</div>
                    <input type="text" id="miss_money" name="miss_money" placeholder="请填写护送回家，可支付酬金"/>
                </li>
            </ul>
            <h1 class="title"> 所属类别</h1>
            <ul>
                <select id="find_type" name="find_type">
                    <option  class="label" value="1">寻找老友</option>
                    <option  class="label" value="2">寻找战友</option>
                    <option  class="label" value="3">家人寻亲人</option>
                    <option  class="label" value="4">亲人寻家</option>
                    <option  class="label" value="5">港澳台寻人</option>
                    <option  class="label" value="6">海外寻人</option>
                </select>
            </ul>
            <h1 class="title"> 归属地区：</h1>
            <select id="find_area" name="find_area">
                @foreach($areaarray as $v)
                    <option value="{{$v->Id}}">{{$v->Name}}</option>
                @endforeach
            </select>
            <h1 class="title"> 联系人信息</h1>
            <ul>
                <li>
                    <div class="label">姓名</div>
                    <input type="text" id="contact_name" name="contact_name" placeholder="必填，联系人姓名"/>
                </li>
                <li>
                    <div class="label">联系方式</div>
                    <input type="text" id="contact_phone" name="contact_phone" placeholder="必填，建议留手机！"/>
                </li>
                <li>
                    <div class="label">QQ/微信</div>
                    <input type="text" id="contact_net" name="contact_net" placeholder="必填电话/微信/QQ"/>
                </li>
                <li>
                    <div class="label">邮箱</div>
                    <input type="text" id="contact_email" name="contact_email" placeholder="必填邮箱！"/>
                </li>
            </ul>

        </div>

        <input class="submit" type="button"  id="send" value="提交登记"/>
        </form>
    </div>
    @stop
@section('js')
    <script src="{{ URL::asset('js/wap/fbxr.js')}}"></script>
    @stop